双气囊小肠镜诊治青年Meckel憩室并出血11例分析
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摘要
目的探讨双气囊小肠镜(double-balloon enteroscopy,DBE)在青年Meckel憩室(Meckel's diverticulum,MD)并出血诊治中的临床应用价值。方法回顾性分析该院2010-07~2018-04期间经DBE诊治的11例MD并出血青年患者的临床资料。结果 (1) 11例患者均以反复解黑便或血便就诊,经其他检查考虑小肠出血或回肠憩室出血,进一步DBE检查发现回肠憩室及出血病灶,诊断MD并出血。(2) 1例出血性憩室溃疡完成DBE镜下止血治疗; 1例回肠动脉出血接受介入治疗; 11例患者最终接受腹腔镜手术(laparoscopic surgery,LS)治疗好转出院。(3) DBE活检6例,符合术后病理诊断4例。(4)随访至2018-04,2例失访,9例无再发出血。结论 (1)对MD并出血者,DBE可直接发现并观察憩室的形态大小和病变,并可行镜下止血治疗,具有较高的临床应用价值,可作为检查的首选方法。(2) MD并出血治疗的根本方法是外科手术,尤其是LS,具有良好的长期疗效。
Objective To explore the clinical application value of double-balloon enteroscopy( DBE) in diagnosis and treatment of Meckel's diverticulum( MD) bleeding in young patients. Methods The clinical data of MD bleeding in 11 young patients who were diagnosed and treated with DBE in the hospital between July 2010 and April2018 were retrospectively analyzed. Results( 1) The 11 patients came to the hospital for consultation because of repeated defecation of black stool or bloody stool. The small bowel bleeding or MD bleeding was considered by some examinations,while ileal diverticulum and bleeding lesions were found and MD bleeding was diagnosed by DBE.( 2)One case of hemorrhagic diverticulitis was completed DBE microscopic hemostasis. One case of ileal artery hemorrhage underwent interventional therapy. Eleven patients eventually receiving laparoscopic surgery were improved and discharged.( 3) DBE biopsy was performed in 6 cases and their diagnoses were consistent with the postoperative pathological results in 4 cases.( 4) The patients were followed up untill April 2018. During the follow-up 2 cases were lost and 9 cases had no recurrent bleeding. Conclusion( 1) MD bleeding can be directly detected and the size and shape of MD can be observed by DBE,and MD bleeding can be treated with microscopic hemostasis.( 2) The radical treatment for MD bleeding is surgery,especially laparoscopic surgery,which has a good long-term effect.
Objective To explore the clinical application value of double-balloon enteroscopy( DBE) in diagnosis and treatment of Meckel's diverticulum( MD) bleeding in young patients. Methods The clinical data of MD bleeding in 11 young patients who were diagnosed and treated with DBE in the hospital between July 2010 and April2018 were retrospectively analyzed. Results( 1) The 11 patients came to the hospital for consultation because of repeated defecation of black stool or bloody stool. The small bowel bleeding or MD bleeding was considered by some examinations,while ileal diverticulum and bleeding lesions were found and MD bleeding was diagnosed by DBE.( 2)One case of hemorrhagic diverticulitis was completed DBE microscopic hemostasis. One case of ileal artery hemorrhage underwent interventional therapy. Eleven patients eventually receiving laparoscopic surgery were improved and discharged.( 3) DBE biopsy was performed in 6 cases and their diagnoses were consistent with the postoperative pathological results in 4 cases.( 4) The patients were followed up untill April 2018. During the follow-up 2 cases were lost and 9 cases had no recurrent bleeding. Conclusion( 1) MD bleeding can be directly detected and the size and shape of MD can be observed by DBE,and MD bleeding can be treated with microscopic hemostasis.( 2) The radical treatment for MD bleeding is surgery,especially laparoscopic surgery,which has a good long-term effect.
引文
1 Clark JK,Paz DA,Ghahremani GG.Imaging of Meckel's diverticulum in adults:pictorial essay[J].Clin Imaging,2014,38(5):557-564.
2 Sagar J,Kumar V,Shah DK.Meckel's diverticulum:a systematic review[J].J R Soc Med,2006,99(10):501-505.
3 Yamamoto H,Sekine Y,Sato Y,et al.Total enteroscopy with a nonsurgical steerable double-balloon method[J].Gastrointest Endosc,2001,53(2):216-220.
4金鑫,金先庆.梅克尔憩室并发症研究新进展[J].现代医药卫生,2014,30(3):393-395.
5 Ymaguchi M,Takeuchi S,Awazu S.Meckel's diverticulum.Investigation of 600 patients in Japanese literature[J].Am J Surg,1978,136(2):247-249.
6白婷婷,王立夫.梅克尔憩室的诊断研究进展[J].内科理论与实践,2016,11(2):108-111.
7 Ackerman Z,Peston D,Cohen P.Role of Helicobacter pylori infection in complications from Meckel's diverticulum[J].Dig Dis Sci,2003,48(6):1068-1072.
8 Bellini D,Maceroni MM,Cavallaro G,et al.CT diagnosis of small bowel obstruction caused by internal hernia from persistent attachment of a Meckel's diverticulum to the umbilicus by the obliterated omphalomesenteric duct[J].BJR Case Rep,2015,2(1):20150131.
9 Sinha CK,Pallewatte A,Easty M,et al.Meckel's scan in children:a review of 183 cases referred to two paediatric surgery specialist centres over 18 years[J].Pediatr Surg Int,2013,29(5):511-517.
10 Lin S,Suhocki PV,Ludwig KA,et al.Gastrointestinal bleeding in adult patients with Meckel's diverticulum:the role of technetium 99m pertechnetate scan[J].South Med J,2002,95(11):1338-1341.
11 Tian Min C,Li Hua X,Ying Lin J,et al.The role of double-balloon enteroscopy following capsule endoscopy in diagnosis of obscure small intestinal diseases[J].Pak J Med Sci,2013,29(2):479-484.
12 Rajesh A,Sandrasegaran K,Jennings SG,et al.Comparison of capsule endoscopy with enteroclysis in the investigation of small bowel disease[J].Abdom Imaging,2009,34(4):459-466.
13 Zhang Q,He Q,Liu J,et al.Combined use of capsule endoscopy and double-balloon enteroscopy in the diagnosis of obscure gastrointestinal bleeding:meta-analysis and pooled analysis[J].Hepatogastroenterology,2013,60(128):1885-1891.
14 Olafsson S,Yang JT,Jackson CS,et al.Bleeding Meckel's diverticulum diagnosed and treated by double-balloon enteroscopy[J].Avicenna J Med,2012,2(2):48-50.
15 Shalaby RY,Soliman SM,Fawy M,et al.Laparoscopic management of Meckel's diverticulum in children[J].J Pediatr Surg,2005,40(3):562-567.
16 Chan KW,Lee KH,Mou JW,et al.Laparoscopic management of complicated Meckel's diverticulum in children:a 10-year review[J].Surg Endosc,2008,22(6):1509-1512.
2 Sagar J,Kumar V,Shah DK.Meckel's diverticulum:a systematic review[J].J R Soc Med,2006,99(10):501-505.
3 Yamamoto H,Sekine Y,Sato Y,et al.Total enteroscopy with a nonsurgical steerable double-balloon method[J].Gastrointest Endosc,2001,53(2):216-220.
4金鑫,金先庆.梅克尔憩室并发症研究新进展[J].现代医药卫生,2014,30(3):393-395.
5 Ymaguchi M,Takeuchi S,Awazu S.Meckel's diverticulum.Investigation of 600 patients in Japanese literature[J].Am J Surg,1978,136(2):247-249.
6白婷婷,王立夫.梅克尔憩室的诊断研究进展[J].内科理论与实践,2016,11(2):108-111.
7 Ackerman Z,Peston D,Cohen P.Role of Helicobacter pylori infection in complications from Meckel's diverticulum[J].Dig Dis Sci,2003,48(6):1068-1072.
8 Bellini D,Maceroni MM,Cavallaro G,et al.CT diagnosis of small bowel obstruction caused by internal hernia from persistent attachment of a Meckel's diverticulum to the umbilicus by the obliterated omphalomesenteric duct[J].BJR Case Rep,2015,2(1):20150131.
9 Sinha CK,Pallewatte A,Easty M,et al.Meckel's scan in children:a review of 183 cases referred to two paediatric surgery specialist centres over 18 years[J].Pediatr Surg Int,2013,29(5):511-517.
10 Lin S,Suhocki PV,Ludwig KA,et al.Gastrointestinal bleeding in adult patients with Meckel's diverticulum:the role of technetium 99m pertechnetate scan[J].South Med J,2002,95(11):1338-1341.
11 Tian Min C,Li Hua X,Ying Lin J,et al.The role of double-balloon enteroscopy following capsule endoscopy in diagnosis of obscure small intestinal diseases[J].Pak J Med Sci,2013,29(2):479-484.
12 Rajesh A,Sandrasegaran K,Jennings SG,et al.Comparison of capsule endoscopy with enteroclysis in the investigation of small bowel disease[J].Abdom Imaging,2009,34(4):459-466.
13 Zhang Q,He Q,Liu J,et al.Combined use of capsule endoscopy and double-balloon enteroscopy in the diagnosis of obscure gastrointestinal bleeding:meta-analysis and pooled analysis[J].Hepatogastroenterology,2013,60(128):1885-1891.
14 Olafsson S,Yang JT,Jackson CS,et al.Bleeding Meckel's diverticulum diagnosed and treated by double-balloon enteroscopy[J].Avicenna J Med,2012,2(2):48-50.
15 Shalaby RY,Soliman SM,Fawy M,et al.Laparoscopic management of Meckel's diverticulum in children[J].J Pediatr Surg,2005,40(3):562-567.
16 Chan KW,Lee KH,Mou JW,et al.Laparoscopic management of complicated Meckel's diverticulum in children:a 10-year review[J].Surg Endosc,2008,22(6):1509-1512.